Effects of Vericiguat on Peripheral Vascular Function and Resting/Exercise Hemodynamics in Patients With Heart Failure With Reduced Ejection Fraction: An Exploratory Pilot Study.

BackgroundVericiguat improves outcomes in heart failure with reduced ejection fraction (HFrEF), but its vascular and hemodynamic effects remain unclear. We explored changes in flow-mediated dilation (FMD) and invasive hemodynamics after vericiguat in symptomatic patients with HFrEF receiving guideline-directed medical therapy (GDMT).MethodsIn this single-center, open-label, single-arm exploratory pilot study, 10 patients with symptomatic HFrEF underwent assessment of FMD, right heart catheterization at rest and during 20-W supine exercise, echocardiography, laboratory testing, and 6-min walk distance (6MWD) before and after vericiguat. Vericiguat was uptitrated to 10 mg/day where tolerated.ResultsAfter treatment, FMD increased from 4.7 (3.0-6.1) to 6.9 (5.5-7.6)% (P = .015), GLS improved from -6.8 (-8.6 to -5.5) to -9.0 (-10.5 to -6.7)% (P = .009), resting cardiac output increased from 3.8 (3.6-5.4) to 4.6 (3.5-5.4) L/min (P = .047), resting systemic vascular resistance decreased from 1664.1 (1327.2-1781.2) to 1293.1 (1143.6-1623.5) dyn·s·cm-5 (P = .002), and 6MWD increased from 334.0 (251.3-395.0) to 355.0 (262.5-453.8) m (P = .036). During 20-W exercise, cardiac output increased from 5.4 (4.6-5.9) to 6.5 (4.8-6.9) L/min (P = .030), whereas exercise systemic vascular resistance showed only a decreasing trend (P = .070).ConclusionsIn symptomatic patients with HFrEF receiving GDMT, vericiguat was associated with changes in peripheral vascular function and resting hemodynamic indices. However, exercise systemic vascular resistance did not improve significantly. These findings are exploratory and hypothesis-generating.